Some signs of high blood glucose levels (BGL) include: increased thirst, weeing more than usual, poor concentration, irritability and tiredness.
High BGLs with raised ketones needs immediate treatment.
Glucose levels can go higher because of:
Missed insulin
Increase in appetite without an increase in insulin doses
Less physical activity without an increase in insulin doses e.g. school holidays
High GI foods
Overtreatment
of hypos
Stress or illness
A recap on ketones
- Insulin allows glucose to move into the body’s cells to give energy.
- Ketones are made when the cells do not have enough glucose.
- Ketones can be made during a vomiting illness associated with normal or low BGLs. The treatment for this is high GI glucose, such as drinking lemonade or taking glucose tablets.
- Ketones + high BGLs is usually associated with missed doses of insulin but also occurs during illness.
- High ketone levels can cause diabetic ketoacidosis (DKA). DKA is a medical emergency and if left untreated is life threatening.
- Some signs or symptoms of high ketones are vomiting, “acetone” smelling breath, abdominal pain, changed conscious state and rapid breathing.
- High ketone levels=1.0 mmol/L or higher if using insulin injections or 0.6 mmol/L or higher if using an insulin pump.
- ++ or +++ ketones on urine test. If any change in colour on urine test, you should check blood ketone level if available.
What to do if the BGL is 15mmol/L or higher
Check ketone levels using either urine ketone strips or blood ketone strips. Having access to ketone checking can assist in early treatment of illness or insulin omission and can help prevent the need for a hospital presentation.
Action if BGL is 15 mmol/L or higher and ketones are high
Managing ketones if using
injected insulin via pen or syringe
Managing ketones if using an insulin pump
Action if BGL is 15 mmol/L or higher and ketones
are not high
Managing high glucose levels with injections when ketones are under 1.0 mmol/L
- Continue normal activity.
- Drink 1-2 glasses of water.
- If using an insulin pump, enter the BGL and accept the correction. Check your BGL again in 2 hours.
- If using a dosing card and injections and you have not given rapid acting insulin within the last 3 hours, follow the dosing card advice for a correction. Check your BGL again in 2 hours.
- Record your BGLs in a record book; you may need a change to your insulin doses if your BGL is high at a similar time each day.
- Check if there is an obvious reason for the high BGL. If there is one, make a note in your record book or on your continuous glucose monitoring a(CGM) app.
- Consider if an overall dose adjustment is needed. This page supports you with making changes to your overall insulin doses.
If you are experiencing many higher BGLs despite following this advice, we suggest you contact your diabetes team for further support
Page updated October 2024
Seek urgent medical attention or call an ambulance by dialing 000 if:
- You have had 3 vomits or diarrhoea or continued stomach pains, especially if these pains are associated with high BGLs.
If at any stage, ketones are 3.0 mmol/L or higher, you should give an 'urgent dose' of rapid acting insulin as explained above and present to hospital for urgent medical assessment. This situation has a high risk of diabetic ketoacidosis (DKA) which is a medical emergency. Remember signs of DKA include; vomiting, stomach pain, rapid breathing, drowsiness.
- After following the above advice, ketone levels are increasing or remain 1.0 mmol/L or higher.
The Royal Children's Hospital (RCH) Sick day service phone number 9345 5522 ask for the 'Diabetes sick day call' 7am – 4.30pm Monday – Friday (for patients of the RCH).